I ,       (name of credit card holder) authorize Bourie Travel to       

Charge my (type of credit card)

Number   Exp. Date   Security Code

in the Amount of      (dollar amount)                                                                                 

 for a reservation to travel on (travel date)

passenger information (names of passengers)

Credit Card Billing Address :                                                                                                                                     

Billing Phone No.  

Issuing Bank and Phone No.  

SIGNED:      (Signature of Credit Card Holder)

WITNESS:         (Signature of Notary)   NOTARY SEAL:    

CUSTOMER:  Please complete the above and return with the following:  

1. A clear photocopy of the front and back of the credit card.

2. Photocopy of a photo identification (drivers license, passport, etc).

NOTE: No third party authorizations for departures from the United States. 

 Credit card holder must be a passenger.